Using a solid phase radioimmunoassay, antibody to hepatitis A virus (anti-HAV) was determined in 3890 sera from populations in seven European countries. Prevalence of anti-HAV was lowest in Scandinavian countries and highest in Greece and France. Antibodies were found in 77 (13%) of 602 blood donors in Sweden, in 29 (17%) of 175 blood donors and women taking birth control pills in Norway, in 273 (39%) of 700 blood donors in Switzerland, in 262 (52%) of 505 blood donors in Holland, in 365 (55%) of 661 accident patients in West Germany, in 452 (75%) of 600 blood donors in France and in 530 (82%) of 647 persons in Greece. Prevalence of anti-HAV increased with age in all populations tested, indicating nearly total exposure to HAV in persons over 19 years of age in Greece and in persons over 39 years of age in West Germany, Holland and France. Antibody was found more frequently in rural than in urban populations in Greece and Switzerland. Calculation of the age-specific incidence of HAV infections suggests a remarkable decline in the exposure rate in the last few decades.
OBJECTIVE: The aim of this study was to investigate ethnic differences in self-reported lack of access to a regular doctor in Malmö, Sweden. DESIGN: The public health survey in Malmö 1994 was a cross sectional population study. Data were collected from 5600 people aged 20-80 years using a postal questionnaire. The participation rate was 71%. The population was categorised according to country of birth: born in Sweden, other Nordic countries, other Western countries, Yugoslavia, Eastern Europe, Arabic speaking countries and other countries. Multivariate logistic regression analysis was performed in order to investigate the importance of possible confounders on the differences by country of origin in lack of access to a regular doctor. RESULTS: A 56.3% proportion of all men and 48.8% of all women lacked access to a regular doctor. The odds ratios of lacking access were significantly higher among men born in Nordic countries, Arabic countries and other countries compared to men born in Sweden but disappeared after adjustment for age. The same patterns were observed for women born in Eastern Europe, Arabic countries and other countries compared to women born in Sweden, and remained after adjustment for age. In the multivariate analysis including age, education, ability to pay bills every month and self-reported health, no significant differences in lack of access to a regular doctor remained among men, while the odds ratios were significantly lower among women born in other Western countries, but still significantly higher among women born in Arabic speaking countries and all other countries. CONCLUSION: Self-reported lack of access to a regular doctor was significantly higher among men born in Nordic countries, Arabic countries and other countries compared to men born in Sweden, but all these differences disappeared after adjument for age and in the multivariate analysis. Women born in Arabic speaking countries and other countries lacked access to a regular doctor to a significantly higher extent compared with women born in Sweden, and these differences remained in the multivariate analysis.
Screening for prostate cancer with prostate-specific antigen (PSA), a simple blood test, is complex, controversial, intellectually challenging and ethically concerning. Sweden has contributed actively to the knowledge base for PSA screening in the last couple of years and a more informed debate is now possible. I will in this article summarize what we currently know about PSA testing. I discuss the closely related issues of the natural history of early-stage disease and the risks and benefits of radical local treatment. I propose that the mortality reduction following PSA screening is probably modest, whilst substantial harms are well documented. Furthermore, there is growing evidence that the PSA test is profoundly limited for screening purposes. I therefore concur with the growing number of health and professional agencies - notably outside the US - that advise against population screening with PSA. Through PSA screening the medical community has generated a pseudo-epidemic of over-diagnosed non-lethal prostate cancer. Molecular tools to distinguish innocent, over-diagnosed prostate cancer from lethal tumors that deserving curative treatment are necessary to improve screening test performance. To date, extensive attempts to identify molecular predictors of outcome have remained unsuccessful, and no ideal screening test is within sight.